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  • MRI-guided Stereotactic Laser Ablation of Mesial Temporal Structures for Refractory Temporal Lobe Epilepsy – Efficacy and Early Outcome

    Final Number:

    Karthik H. Madhavan MD; Jonathan R. Jagid MD; Ramses Ribot MD, Enrique Serrano MD; Meredith Lowe MD; Gustavo Rey MD; Leticia Tornes MD; Andres Kanner MD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2015 Annual Meeting

    Introduction: Laser ablation of the refractory temporal lobe seizures was first reported about 2 years ago. This is a minimally invasive approach for the resection of affected temporal lobe. We present our data on epilepsy patient treated by the second author.

    Methods: We performed a retrospective chart review of 15 patients who underwent this procedure and during November 2013 to April 2014. Patients were followed at one, four, twelve and 24 weeks after surgery. During each visit, we evaluated for seizure frequency, cognitive, neuropsychiatric and psychiatric symptoms as well as any adverse event of AEDs.

    Results: Our data revealed the mean age was 44 years with seven patients over 50 years. All patients were right handed. One patient had bilateral independent ictal foci, with >90% of seizures from the ablated side. Another had dual pathology with an ipsilateral focal dysplasia posterior to the left hippocampus. Eleven patients have been seizure free, and two reported auras. Two patients had a breakthrough seizure after missing several days of their AEDs. There were no neurological or neurosurgical complications post-surgically. Recurrence and /or worsening of existing depression occurred in 5 patients and a hypomanic episode in one. Our first patient reported a mild worsening of his verbal memory. Neuro-psychology evaluation was performed on 7 of them at the time of this abstract and were evaluated for multiple outcomes but mainly visual memory for the non dominant side and verbal memory for the dominant side. Our first patient had worsening of the verbal memory but there was no deterioration among the rest.

    Conclusions: Minimally invasive laser ablation is an excellent alternative option for open resection of temporal lobe. Further long term follow up necessary for before it can be the standard of care.

    Patient Care: surgeons will be aware that laser is a good alternative less hospital stay minimally invasive leads to less infection rate

    Learning Objectives: 1. Laser ablation of temporal lobe in intratable epilepsy is a feasible option. 2. Minimally invasive lead to less infection


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